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Home My WebLink About11077-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... Z137.R5 ..... Date ........... ~AgU~..%~ ........... 19 ~.~ THIS CERTIFIES that the building .... .ct~¢k... ..................................... Location of Property .... $ 82.0. ............ Tt:~. ,I4o. r~bL .W.~y ............ .E.a.s.t...M.a.r.i.o. rL.. House No. Street Hamlet County Tax Map No. 1000 Section .. 3. Q ....... Block ...... ~ ........ Lot .... Z. 2. 9. .......... Subdivision Pebble Beacl% Farms .Filed Map No .... 6.2.66.Lot No. 45 conforms substantially to the Application for Building Permit heretofore filed in this office dated March 16 19 8 J~. pursuant to which Building Permit No. 1 J..0.7. 7 $. dated Mar ch 26 1981. was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Construct & enlarge existing deck. The certificate is issued to EDWARD & DOROTHY ALBER ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval .................. .N./.A. .................... UNDERWRITERS CERTIFICATE NO. N/A Buildmg Inspector Rev. 1/81 FORM NO, 2 ,TOWN O~ SPUTUOLr~ BUILDING D~AR"rME~I~: TOWN HALL SOUTH'OLD, N~. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11{)77 Z Permission is hereby granted to: /(',/( ....................... ~'./.~.L~.OzE.~.d... ~..~r,'7;~ /~ ~/ ...... ~L.Z~.~,.....X~..:~.:....~' ........ ,~ ...... a~.~.~.~z......~....~,~.~:....~x~.~,~..~.~,-- ~'~ ................... ........................ .~.~ ........ ~Z~ ...... 5.~,~.~-- -/: .......................................................... · ~ ........................ g ................................................ ~ ................ ; .............. ~ ........................... ...... ................. ........... Coun~ T~x ~,p ~o. ]000 Soction ....~.sx .......... glock ................. ~o. pursuont ~o ~pplicotion da*od ..~.~'. ........ ~.~ ............. .5....., 19.~,, ~nd ~pprovod by the Building Inspector. Fee $..../...~.'.ii~'~.~. ....... · B~ildihg/ilnspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Buiidlng Department Town Hall Sou~hold, N.Y. 11971 A?PLtCAT~ON FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s ~oficat~on must be filled in typewriter OR ink, and subn~itted in duplicate to the Building Inspec- tor,,v~m the following; for new buildings or new use: 1. Finer sun,'e¥ of property with accurate location of all build[n§s, property lines, streets, and unusual .'latdral Or tooograohic features r*m, eoorove of Hea~tr~ Dept. of water supoty and sewerage dmposal--(S-9 form or equal). 3. Acprcval of alec~rtcat installst~on from Board of Fire Underwriters. 4, Commerctal buildings, Industrial buildings, Multiple Residences and similar bufldings and installa- tlons, a car~dlcate of Code compliance from the Architect or Engineer respons;ble for the buiiding. 5. Buom~[ Planning Board approvaJ of completed site plan requirements where applicable. B. For existing buitdmes (prior to Aprd 1957), Non-conforming uses, or buildincs and "pre-existing" land uses ~ 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn s~atement of owner or previous owner as to use, occupancy and condition of buildings. 3. Data of any housing code or safaw msoect~on of buddines or premises, or other pertinent Informa- tion required to prepare a certificate. / ~ 1. Certificate of occupancy $5.00 2. Car[d~cate of occupancy on pre-exmtmg dwelling or land use 3. Copy of certificate of occupancy $5.00 Ne'.,/ Building ............. Old or Pre-existing Bu~lding(~) ........ =/Vacant Land - . ....... Owners of Property County Tax Map No. 1000 Section .............. Block ...0 ......... Lot .............. .............................. ' ' · ......... Lot No ............. Health Dept. Approval ........................ Labor Dept. Approval ......................... Unde¢.vr~ers Approval ........................ Planning Board Approval .................. Request for Temporary CertifiCate ..................... Final Certificate ........ - ......... Fee Submitted S ............................. Cor. struct~on on above described build,ng an~;~t~ a;lz~ca~o.~s ~d ragu lateens' Iq ........ FIELD INSPECTION FOU~DAT~OW (ISt) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTttOLD, N.Y. 11971 TEL.: 765-1803 5xamined ,~./~. (..C~..4.4'4., 19.~./. i~sPa;;;:dved~a(i'cf' '/' · · 'z~'f' ' ', 19: '~' ' Permit N°' · f'/'~' · '~' '~' '7~ / · / ........ :~7.......: ........ ., .......... , .................. T: :?.~. ................... ~., (Btiildin/'g Inspector) APPLICATION FOR BUILDING PERMIT Application No. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building nspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets *r areas, and g~ving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 'ation. c. The work covered by this apphcation may not be commenced before issuance of Building Pe.rmit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ,hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ;hall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described· 17he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildings for necessary inspections. · p./. ....... (Signature of applicant, or name, if ~corporation) .... ~.n ~..~.~. s.~.'.~'....~Y'~.~.-4'.~e .............. (Mailing address of applicant) :~tate whether applicant is owner, lessee, agent, architect, engineer, ge~er~l 'contractor, electrician, plumber or builder. qmue of owner of premises . J~. ~b..~q,~ ....................................................... (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. .... £ ........ (Name and title of corporate officer) Builder's License No....~-.~7.~ .................. Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .... ~f~t([C. ~...~.o.~ ................................ X .x: ........................................... ........... ;ZZ':'~"'~ ...... l'x'r~'-' ~t feet Hamlet House Number County Tax Map No. 1000 Section ....... ?. ........ Block O ,~ Lot ./'~ 5? Subdivision ?. ,~.~/?/.s'.~.C..,.-~H ' Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... /..~.~.':'.U../.-O-.-~. ................................................... b. Intended use and occupancy ..... ~--~-'A~v~...~. .~.~-./5~ ........................................ 3. Nature of work (check which applicable): New Building .......... Additiot~ ...... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... ~ (Description) ' Fee L Estimated Cost ...... · (to be paid on filing this application) L If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars ' 5. If business, commercial or mixed o¢cupancy, specify nature a~)d extent of each type of use .................... 7. Dimensions of existing structurqs, ifany: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ...................................................... Dhnensions of same structure with alterations or additions: Front ................. Rear ................ D.epth .................... '.. Height .... : ................. Number o[ ~!~ries ........... Ye ....... L rhmensions of entire new construction: Front . Z2 ./1 .o./i ..... Rear ).~ .......... Depth . / ~. ........ Height Number of Stories ). Size of lot: Front ...................... Rear ...................... Depth .................... ). Date of Purchase ............................. Name of Former Owner ........................... [. Zone or use district in which premises are situated. ................................................. D d 1 i d' ' ~.. des propose construction Vid ate any con ng law, or mance or regulatmn: ........................... t. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No L Name Of Owner of premises . ~'D .,(, ~ ~K. ........ Address goT.z/5''. ~2~/~./~'7~o',t. Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor . I~o.~e,r.'iT..~.c~c~e.q/g.c .~.g... Address .~..~.o~./~-.~..:~-..~..~-.~. Phone No..c/.~2.~. 7'./.k". ?~.... PLOT DIAGRAM Locate .clearly and distinctly fil buildings, whether existing or proposed, anti, indicate ',~l s~t-back dimensions from -operty lines. Give street and blocknumber or description according to deed, and show street names and indicate whether terior or corner lot. rATE OF NE~01~I~,, // ~, ~, OU .i~r.Y 0~.. ~'* ....... i~,,~, J~P~. ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contr~(e't) dove named. e is the ........................................................................................ ~'ent, corporate officer, etc.) f said owner or owners, and is duly authonze~/~ffto perform or have performed the said work and to make and file this pplicat~on, that all statements contained in this application are true to the best of his knowledge and behef; and that the ~ork will be performed in the manuer set forth in the application filed therewith. worn to before~me this ..... d~...~.~.~.'~'¢' ..........day of ..... ~.~ .... ,19 .~ Iota Noeary Public, S~ato of New York .... ,5 .............. No. 52-0344963 Suflolkl Coun~tY~/.~ /~(a3ignature of applicant) Coraralssion £xp~res Maroh'$0t , et ~1.